Hospital Hews to Guidelines on the Poor, Chief Insists

Robert Parks didn’t feel much like talking Friday afternoon as he lay in his bed at Los Angeles County-USC Medical Center. While other patients in the room visited with family and friends, Parks stared vacantly at the wall, scratching his beard or running his hand through his hair.

Parks, 56, a transient who has been listed in serious condition for more than a week, is suffering from anemia, dehydration and malnutrition, as well as from alcoholic withdrawals, doctors say. He still is apparently unaware of his role in a Burbank hospital scandal, or how closely county health officials are monitoring his progress.

Parks is one of the pivotal figures in a probe of Burbank Community Hospital, a 103-bed facility that officials suspect may be administering improper and inadequate medical care to indigent patients.

The county Department of Health Services has added at least two other cases to the three it was investigating in which indigent patients have died at the hospital, were denied help or needed hospitalization soon after doctors released them.

As facts about the cases under study began to emerge last week, hospital administrators maintained that health officials were unjustly criticizing the institution.

“They’re trying to put a morality on this,” hospital Administrator Jurral Rhee said in an interview. “We’re just shaking our heads over here.”

Rhee said his hospital was following federal and state guidelines by treating indigents who needed emergency care and releasing them after they were stabilized.

The investigation follows a report by county health officials that criticized treatment of an unemployed patient who died at the hospital last month.

Burbank Community was one of eight hospitals in the San Fernando Valley area that were cited last year by a federal agency as having an unusually high mortality rate of Medicare patients. Rhee called that study erroneous and misleading.

But Burbank police officials said they have been involved in recent incidents in which patients were released from the hospital but still seemed to need medical care. Those incidents warranted investigation by health officials, they said.

Irregularities Noted

“We’re not necessarily saying that there’s any wrongdoing going on,” said Detective Kevin Krafft. “We don’t have the resources to determine that. But there appear to be some irregularities. It could be simply that there’s a problem with the system that needs to be straightened out.”

Parks was taken by paramedics to Burbank Community Aug. 29 after police found him collapsed on the street and covered with lice and dirt, police said. The next day, police were summoned to an area near the hospital, where they found Parks again on the ground and covered with dried blood and “a multitude of insects,” said Capt. David Newsham.

Hospital officials refused to readmit Parks, even though police said he was disoriented and complaining of pain, Newsham said. The officials said they had already treated Parks, giving him medication, and that there was nothing more they could do.

Police transported Parks to County-USC Medical Center. Emergency room physicians there said Parks was badly infested with lice and maggots and needed immediate medical attention, Newsham said.

Although declining to speak on the investigation into Parks’ treatment at Burbank Community, David Childress, supervisor of the enforcement and surveillance unit of the county health department, said, “Mr. Parks is still at County-USC in serious condition after a week. What does that tell you?”

Childress said that, in Parks’ case, Burbank Community could or should have arranged to transfer him to a county hospital. However, Rhee said that would have been “patient dumping.”

Another case that involved Burbank police and the hospital concerned Shirley Wright, 50, a homeless woman.

On March 8, Wright told police, she was sitting at a bus stop in the 1100 block of North San Fernando Road at 1 a.m. when two men in a car picked her up, robbed and beat her before dumping her on the street. Police found Wright in the middle of the street near Buena Vista Street and Thornton Avenue.

“She had a possible broken nose, swollen mouth and several teeth were missing,” Krafft said. “We summoned paramedics, who transported her to Burbank Community.”

Hours later, Lt. Don Brown was at the Burbank police station when Wright wandered into the lobby. She had apparently walked the 1 1/2 blocks from the hospital.

‘Death Warmed Over’

“When she came in, there was blood dripping from her face,” Brown recalled. “Her face was covered with bandages, but the blood was oozing from the bandages. She looked like death warmed over. Her hair was still matted with blood. She had a tissue, and was wiping blood from her mouth and nose.”

Brown said Wright seemed very scared and tired. When he asked her if she wanted to go back to the hospital, she refused.

“She said she was tired and just wanted to get some sleep, but there was no place for her to go,” he said.

Brown notified the Burbank chapter of the Salvation Army, and staff members took Wright to a motel, he said. Later in the week, they took her to County-USC Medical Center, where she was hospitalized.

Questioned about Wright’s case, Rhee said his hospital is not required to render treatment beyond what she received in the emergency room.

Transfer Inappropriate

“She was not in need of emergency assistance, which is not to say she wasn’t suffering from malnutrition,” he said. He said it also would not have been appropriate for his hospital to transfer her to another hospital.

Rhee also defended his staff’s treatment of Parks.

“By what stretch of anyone’s imagination is it our responsibility to hospitalize someone like that?” he said. “If you go along Skid Row, and you pick up 10 transients or winos, how many of them do you think would be suffering from delirium or malnutrition or anemia?

“I’m not saying that he may not have been in need of additional medical care,” Rhee added. “But it’s not a requirement of a community emergency room to admit someone as a courtesy or social service.”

The emergency physician on duty at Burbank Community had to make a judgment on readmitting Parks, he said. “There’s no need to treat a patient a second time if, in the physician’s best clinical judgment, the patient does not need hospitalization in the next hour. That’s why we have county hospitals.”

Rhee has been in charge of Burbank Community for more than four years. He was former director of Lakeview Medical Center.

Medicare Hospital

Burbank Community, a licensed Medicare hospital with a 24-hour emergency room, is required by government funding rules to treat indigents. But, after indigent patients are cleaned and stabilized, Rhee said, they are told to go to their private doctor or a county hospital for further treatment.

Rhee also criticized Parks’ handling by Burbank police. “The police have a responsibility to take care of vagrants, but they call and bring them to us,” he said. “They had a greater responsibility, but they dumped it on us.”

Before the Parks incident, county health officials had already criticized the hospital’s actions in treating Robert Shufflin, 24, an unemployed man from Texas who had been in town for only a few days.

On Aug. 12, Shufflin was arguing with his brother as they drove around Burbank, Krafft said. As the car was moving on Scott Road and Haven Way, Shufflin opened his passenger door and stepped out, police said. He was run over and suffered massive head injuries, authorities said.

Shufflin died Aug. 18 at the hospital, officials said.

The health department filed a statement of deficiency against the hospital for its treatment of Shufflin. They said he was not admitted as an emergency patient, even though he had head trauma.

The statement alleged there was no documentation from nurses on the 3-to-11 p.m. shift Aug. 13 to show that doctors’ orders had been followed to monitor Shufflin’s condition. Also, it was unclear whether soft restraints were placed on Shufflin in his bed or, if they were, how they were placed on him.

Rhee said investigators were mistaken about Shufflin’s treatment. He said Shufflin was admitted as an emergency patient. And he said nurses’ failure to note his condition and treatment on Aug. 13 was an “oversight.”

Health investigators were also studying the case of John M. Simpson, 33, a transient who was admitted after being severly beaten in July. Simpson died at the hospital July 29.

Rhee said a head-trauma case such as Simpson’s should have been transported by paramedics to a trauma center. Rhee said his hospital does not have a trauma center, but that St. Joseph Medical Center, also in Burbank, does.

“Why weren’t they taken there? It’s just a thought,” Rhee said.

8 Hospitals Listed

Burbank Community was one of eight Valley-area hospitals listed last year by the federal Health Care Financing Administration as having an unusually high mortality rate for Medicare patients suffering from certain illnesses and injuries.

The report said Burbank Community had a high mortality rate among patients requiring heart pacemaker implants and knee and hip surgery. Of 15 pacemaker patients, the report said, 20% died. The predicted death rate was 2.9%. In addition, 11.7% of 17 knee and hip patients died, although the predicted death rate was 3.3%.

At the time, Rhee attacked the validity of the report, saying that 15 patients did not constitute an adequate sample.

Burbank Community was not named in this year’s report by the agency.

Rhee said he is sure that the current investigation will clear him and his hospital of any wrongdoing in the care of the poor.

“We don’t look at the wallet, we look at the needs of the patient,” Rhee said. “We often get stuck for many thousands of dollars. If an indigent is unstable, we admit them and take care of them. We do that or the government would retract our approval for Medicare admissions.”